Hey Everyone!! 😊
It's been a little while since we've heard from Alyce, and I think the pandemic has highlighted even more just how much a problem this is, so here's a little glimpse at the inner workings of the US healthcare system. Enjoy... 😉
"First of all, I'm not going to try to justify why medical providers sometimes are more concerned with a patient's ability to pay than they are with treating the patient's medical issues, but I will try to explain it. There are a lot of expenses involved in practicing medicine in the United States. If you're talking about individual doctors, they have to complete, and pay for, more than a decade's worth of higher education before they can take the tests that allow them to earn their medical licenses. Many of them have tens, if not hundreds, of thousands of dollars in education loans they have to pay off."
"Wait a moment," interrupted Squid-boy. "Are you saying that your society requires that healers pay for their own training? That you don't train your healers as an investment in ensuring that your people have access to medical care when they need it?"
I nodded. "Yep. That's what I'm saying. People who want to become doctors have to find a way to pay for their education themselves. Some are able to get grants or scholarships, but a lot of them have to either pay cash or take out loans to pay for it. And those loans charge interest, so it can be incredibly expensive to become a doctor."
"That's barbaric!"
"Well, sugar, I can't say that I disagree with you. But that's the way it is. And when a doctor has the banks breathing down their neck wanting their loan payments, you can see why they might be a tad anxious to make sure the patients they treat are able to pay them."
"Yes. Though, I still maintain that it's an uncivilized way of doing things."
"True. But that doesn't change the reality. And you also have to consider that if a doctor owns their own practice, they also have to pay the salaries of all their nurses and other staff, they have to pay someone to do their billing for them, they have to pay for all the medical supplies and medications they use, which aren't cheap, and they have to pay for utilities and clerical supplies. Probably a cleaning service, as well. So, doctors really do need to make sure that they get paid for their services."
"Why is billing a separate expense? Why don't patients simply pay for their treatment at the time of service?" asked Yax.
"Well, sugar, that gets into insurance, which I'll get to later. And, speaking of insurance, it's not just medical insurance doctors have to deal with. They also have to have malpractice insurance and insurance on the building where they practice and its contents, too. It all adds up. And hospitals have all those expenses plus additional administrative expenses and the expenses associated with maintaining sterile operating rooms and the specialized staff that goes along with them. And the supplies and equipment hospitals need are also more specialized, and expensive, than what is used in a regular doctor's office. Plus, they have to pay the doctors, too."
"Will you explain about the insurance now?"
I snorted. "Sure. Like I said, there are several kinds. There's insurance on the building and the contents of the building, in case something happens, like a fire or flood, that destroys the property and equipment. There's liability insurance, in case someone does something like slip and fall and hurt themselves on the premises. There's malpractice insurance, in case a doctor makes a mistake that injures a patient or results in a patient not receiving the correct treatment and suffering injury as a result. These are all insurances that doctors and hospitals have to carry and pay for."
"So, they pay money to a company each month and that company guarantees to pay if anything happens that applies to the type of insurance they provide?"
I nodded. "Yes, though, like I said, in theory. Insurance companies only make money if they don't have to pay out too much, so they try not to pay if they can get away with it."
"How do they do that?"
"It depends on the type of insurance. Most types of insurance have limits on the payout, so the insurance company won't pay anything above that limit. Aside from that, they'll try to find excuses for why they shouldn't have to pay."
"What kind of excuses?"
"Again, it depends on what kind of insurance we're talking about. For medical insurance, which is supposed to pay for medical treatment if the insured person gets sick or hurt, there are a few different ways insurance companies try to get away with not paying. For example, if a doctor prescribes a certain medication for a person, their insurance company might refuse to pay because they have decided that medication won't be covered. So, the patient then has to either get their doctor to prescribe something else that is covered or pay for the medication themselves."
"What if the medication that isn't covered is the only medication that will meet the patient's needs?"
I shrugged. "They might be able to get the insurance company to pay for it if they argue the case and get their doctor to back them up, but they might not. And even if they do, they usually end up having to pay a higher price for that medication than they would for a medication that was covered."
"Wait a moment, I'm confused. If they successfully make their case that the medication should be covered, why does the patient have to pay anything for it? Doesn't that mean the insurance company will pay?"
"Ah, well, that's one of their other tricks. Most medical insurance policies have what are called 'deductibles' and 'copays'. The insurance doesn't pay for anything until the patient has paid out enough money to cover their deductible, which is usually thousands of dollars, for the year. And even after the insurance company starts to pay, they only pay for a percentage of the costs. The rest of the costs have to be paid for by the patient. That's what's called a 'copay'."
"And patients have to deal with all of this while they are sick or injured, possibly fighting for their lives?"
"I'm afraid so, sugar."
"I have to agree with Paxtiguantialablingondintalblinganham, your system for healthcare is barbaric."
I shrugged. "I won't argue with you. It used to be worse. It used to be that medical insurance companies were allowed to refuse to pay if they claimed an illness or injury had existed before the patient bought their insurance. Guess how often that claim was made?"
"From what you've described, I'd wager that it was more often than not."
I nodded. "And they also used to be allowed to set limits on how much they would pay for a patient for a year and also for their whole life. But a law was passed that made it illegal for them to do that, so they don't anymore. But there are still plenty of other tricks they use to get out of paying."
"It occurs to me that, depending on the circumstances, if one of your insurance companies can play such games long enough and prevent the patient from receiving care, the issue of their having to pay may become moot if the patient dies in the meantime," observed Squid-boy.
"Yep. That's certainly a possibility. And having a specialized staff who are trained in how to argue with insurance companies and convince them they have no choice but to pay is why doctors and hospitals have to pay for billing staff."
"And the expenses that your healthcare providers are forced to bear are the reason why patient's lives are allowed to depend on the caprices of private industry?"
I shook my head. "No. The reason that happens is because my country has allowed our healthcare system to be controlled by for-profit corporations. Since their profits are dependent on not paying for healthcare, there's a built-in perverted incentive structure that can't be overcome. As long as those corporations are allowed to continue to control our healthcare system, people will continue to die from lack of care. The expenses that providers have to cover are the reason why they sometimes are more concerned with a patient's ability to pay than they are with the patient's health status. But the reason some patients aren't able to pay is because our government has failed to prioritize ensuring that all our citizens’ healthcare needs are taken care of."
"And there's nothing that can be done about that?"
I shrugged. "There's plenty that could be done. Every other modern country on our planet has some form of guaranteed healthcare coverage through their government, which they pay for with taxes. But, so far, the politicians in my country have lacked the political will to do anything like that. Mostly, because they've been bribed by the same corporations that are currently running the healthcare system."
"Which ties back into the rampant corruption in your political system that we discussed before," said Yax.
"Yep."
"Has no one ever tried to do anything to curtail the expenses associated with providing healthcare?" asked Squid-boy.
I sighed. "Sure. The costs associated with healthcare are routinely used to justify keeping salaries low for lower-level employees in the healthcare system and for denying them many benefits."
The two aliens looked at each other. "This is a new aspect of the problem that we weren't aware of. Can you explain?"
I opened my mouth to answer when a strobe light flashed behind my eyes and a jagged piece of agony sliced through my brain. My vision went red and I felt my legs fold under me. I'm pretty sure I lost consciousness for a few seconds, because the next thing I knew, I was on the floor looking up into two faces that were clearly showing concern despite their alien features.
"What happened?"
Want to find out what happened? Grab your copy at the link below. Happy reading! 😊
